Provider First Line Business Practice Location Address:
1817 NE 17TH AVE
Provider Second Line Business Practice Location Address:
3550 N. INTERSTATE AVE.
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97212-4509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-249-6229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2006